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Flashcards in hematologic malignancies Deck (25):
1

what are the major hematologic malignancies (8)

acute myelogenous leukemia (AML)
acute promyelocytic leukemia (APL)
acute lymphocytic leukemia (ALL)
chronic myelogenous leukemia (CML)
chronic lymphocytic leukemia (CLL)
Hodgkin's lymphoma
non-hodgkins's lymphoma
multiple myeloma

2

what cancer is an unregulated proliferation of myeloid line progenitor cells

acute myelogenous leukemia (AML)

3

what are the signs and symptoms of acute myelogenous leukemia

1. malaise
2. bone pain
3. fever
4. gum hypertrophy
5. CNS effects (headache, seizure, visual; usually in ALL)

4

what are some poor prognostic factors with AML?

older than 60
elevated WBC (100,000)
CNS involvement
Infection
Secondary from other cancer
myelodysplasia
Organ impairment
unfavorable cytogenetic karyotype (deletion of chromosomes 7 or 5)

5

what are the treatment options for myelogenous leukemia (AML)

1. induction = cytarabine for 7 days and daunorubicin, or idarubicin for 3 days
2. consolidation = high dose cytarabine or allogeneic stem cell transplant

6

what are some common complications with cytarabine and daunorubicin or idarubicin

pancytopenia
GI problems
Tumor lysis syndrome
Cardiotoxicity
hand-foot syndrome (rash) from cytarabine

7

what is more harsh; 3000 mg/m2 cytarabine BID or continuous 100 mg/ m2 cytarabine for 7 days

continuous 100 mg/ m2 is much more toxic

8

what is the dose limiting effect of cytarabine

cerebellar toxicity; must have neurological exams during high dose regimen

9

what can be done to prevent conjunctivitis in patients on cytarabine

dexamethasone eyedrops QID

10

what can be done to prevent conjunctivitis in patients on cytarabine

dexamethasone eyedrops QID

11

what is the best option for high risk patients with myelogenous leukemia

allogeneic stem cell transplant

12

what is the best option for treating elderly patients with myelogenous leukemia

supportice care with transfusions and antibiotics

13

what can be given to elderly patients with myelogenous leukemia who have had prior hematologic disorders

decitabine or azacitidine

14

what are the options for AML relapse

1. clinical trial
2. salvage chemotherapy
3. allogeneic transplant
4. autologous stem cell transplant

15

what is a form of AML that is diagnosed by the presence of translocation 15;17

acute promyelocytic leukemia (APL)

16

what is the APL mechanism

1. translocation of 15;17
2. RARA protein turns into PML-RARA
3. Promyelocytes build up and never mature into granulocytes

17

what is the deadliest form of leukemia if untreated

APL (acute promyelocytic leukemia)

18

the induction treatment of APL (acute promyelocytic leukemia) includes what

ATRA 45 (all-trans retinoic acid), or tretinoin

19

ATRA 45 is a derivative of what?

vitamin A

20

the induction treatment of APL (acute promyelocytic leukemia) includes what

ATRA 45 (all-trans retinoic acid), or tretinoin
with "7 + 3"
or ATRA plus arsenic for poor performance status (and low risk)

21

ATRA 45 is a derivative of what?

vitamin A

22

What is the MOA of ATRA

breaks down PML-RARA fusion protein allowing promyelocytes to differentiate

23

What are the adverse effects of arsenic?

QT prolongation

24

What is a common complication for treatment with ATRA

APL Differentiation Syndrome - huge cytokine release due to sudden differentiation of leukemic cells

25

what is treatment for APL differentiation syndrome

stay on ATRA (even though may appear septic) and treat with steroids